Provider Demographics
NPI:1174615082
Name:GIBSON, ERIC E (MSW LICSW)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:E
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MALBERT RD
Mailing Address - Street 2:#2
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-782-6805
Mailing Address - Fax:
Practice Address - Street 1:30 WARREN ST
Practice Address - Street 2:FRANCISCAN HOSPITAL FOR CHILDREN
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-254-3800
Practice Address - Fax:617-779-1235
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1134561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical